助产士强化沟通模式对产妇分娩应激表现及产程的影响

Effect of midwify intensive communication model on stress performance and birth process of parturient women

目的探讨助产士强化沟通模式对产妇分娩应激表现及产程的影响。方法选取2013年6月-2015年4月该院收治的初产妇86例为研究对象,采用随机数表法分为观察组和对照组,各43例。对照组采取常规沟通模式,做好产前检查和孕期指导;观察组在此基础上对沟通环节进行强化,以相关健康教育为主。比较两组产妇配合率,同时观察两组术前与术中焦虑、恐惧程度,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)分析并比较两组应激表现,记录产程时间及产后出血量,比较两组产妇妊娠结局(剖宫产率、产褥感染率、盆腔粘连发生率、母乳喂养率)与新生儿结局(新生儿Apgar评分、体重)。结果观察组配合率(86.0%)明显高于对照组(67.4%),差异有统计学意义(P<0.05);产前观察组SAS评分(56.34±4.16)分、SDS评分(63.24±1.56)分与对照组(56.33±4.15)分、(63.25±1.55)分比较,差异均无统计学意义(均P>0.05);干预后观察组SAS评分(74.30±1.75)分、SDS评分(20.44±3.62)分、产后出血量(251.02±60.41)ml明显低于对照组(89.35±4.20)分、(41.15±1.14)分、(275.38±48.46)ml,差异均有统计学意义(均P<0.05);观察组产程时间(416.26±165.23)min明显短于对照组(497.01±198.43)min,差异有统计学意义(P<0.05);观察组剖宫产率(16.3%)、产褥感染率(4.7%)、盆腔粘连发生率(7.0%)低于对照组34.9%、18.6%、23.2%,差异均有统计学意义(均P<0.05),且其母乳喂养率(86.0%)高于对照组(67.4%),差异有统计学意义(P<0.05);两组新生儿体重(3.14±0.03)kg、(3.16±0.01)kg比较,差异无统计学意义(P>0.05);观察组新生儿出生后5 min、10 min Apgar评分(8.93±1.21)分、(9.85±0.04)分高于对照组(8.54±0.33)分、(9.41±0.02)分,差异均有统计学意义(均P<0.05)。结论助产士强化沟通模式可有效降低产妇分娩应激表现,缩短产程,并改善产妇与新生儿结局,值得在临床推广应用。

Objective To explore the effect of midwify intensive communication model on stress performance and birth process of parturient women.Methods Eighty-six primiparous women treated in the hospital from June 2013 to April 2015 were selected as study object,then they were divided into observation group and control group according to random number table,43 primiparous women in each group.The primiparous women in control group adopted routine communication model,prenatal examination and pregnancy guidance;and the primiparous women in observation group adopted midwify intensive communication model based on control group,health education was the main content.The coordination rates in the two groups were compared between the two groups.Meanwhile,the preoperative and intraoperative anxiety and fear degrees in the two groups were observed.The stress performance was analyzed and compared by SAS and SDS.The time of birth process and postpartum bleeding volume were recorded.The pregnancy outcomes（the rate of cesarean section,puerperal infection rate,incidence rate of pelvic adhesion,breastfeeding rate） and neonatal outcomes（neonatal Apgar score,weight） were compared between the two groups.Results The coordination rate in observation group was 86.0%,which was statistically significantly higher than that in control group（67.4%）（P〈0.05）;SAS score and SDS score before delivery in observation group were（56.34 ± 4.16） points and（63.24 ±1.56） points,respectively,compared with control group [（56.33± 4.15） points and（63.25± 1.55） points],there was no statistically significant difference（P〈0.05）;after intervention,SAS score,SDS score,and postpartum bleeding volume in observation group were（74.30±1.75） points,（20.44±3.62） points,and（251.02±60.41） ml,respectively,which were statistically significantly lower than those in control group [（89.35±4.20） points,（41.15±1.14） points,（275.38±48.46） ml]（P〈0.05）;the labor time in observation group was（416.26±165.23） minutes,which was statistically significantly shorter than that in control group [（497.01±198.43） minutes]（P〈0.05）;the rate of cesarean section,puerperal infection rate,and pelvic adhesion rate in observation group were 16.3%,4.7%,and7.0%,respectively,which were statistically significantly lower than those in control group（34.9%,18.6%,23.2%）（P〈0.05）;the breastfeeding rate in observation group was 86.0%,which was statistically significantly higher than that in control group（67.4%）（P〈0.05）;there was no statistically significant difference in neonatal weight between observation group and control group [（3.14±0.03） kg and（3.16±0.01） kg]（P〉0.05）;neonatal 5-minute Apgar score and 10-minute Apgar score in observation group were（8.93±1.21） points and（9.85±0.04） points,respectively,which were statistically significantly higher than those in control group [（8.54±0.33） points and（9.41±0.02） points]（P〈0.05）.Conclusion Midwify intensive communication model can effectively reduce stress performance of parturient women,shorten birth process,and improve maternal and neonatal outcomes.It is worth to be popularized in clinical application.